Does R06.03 require prior authorization?

No, R06.03 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R06.03`, Acute respiratory distress

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The patient's medical record must document medical necessity including relevant medical history, physical examination findings, and results of pertinent diagnostic tests or procedures supporting the clinical diagnosis and specific reason for the study.
All segments of the cardiovascular nuclear medicine service must have a formal interpretation and report documented in the medical record.
The referral/order must include the medical indication for the study and be retained in the patient's medical record.
When CPT 78472 and add-on 78496 are submitted with perfusion codes 78451-78454, the formal reports must explicitly state that simultaneous first-pass cardiac function studies were performed and that the laboratory has equipment capability to perform such studies.

Cardiovascular nuclear medicine testing is reimbursable for risk assessment or re-evaluation in asymptomatic patients or patients with stable symptoms who have known atherosclerotic heart disease on catheterization or SPECT perfusion imaging, provided the patient has not undergone a revascularization procedure within the prior 2 years.
Blood pool scan to assess left ventricular ejection fraction prior to implantation of an implantable cardioverter-defibrillator (ICD) or biventricular pacemaker is covered when the medical record documents the intended plan for device insertion and the test result.
Simultaneous cardiac function studies using the first-pass technique performed with perfusion imaging (CPT 78451-78454) and reported with CPT 78472 and add-on 78496 are covered when the formal report documents that first-pass cardiac function studies were performed and the laboratory is equipped to perform them.
Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J18

WPS-J5-L35121, Coronary Computed Tomography Angiography (CCTA)

WPS-J5-L39913, Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

Ask Backwork about documentation requirements, denial risks, or coverage in your state.